Routine Systematic Prostate Biopsies not Replaced by Magnetic Resonance Imaging-Targeted Biopsy

ABSTRACT Background: Multiparametric magnetic resonance imaging improves the performance of prostate cancer (PCa) diagnostics through a better selection of patients. Objectives: The aim of the study was to study the detection rate (DR) of systematic and targeted cognitive biopsies in a cohort with the previous negative systematic biopsies. A secondary objective was to describe the value of prostate-specific antigen density (PSAd) in the detection of clinically significant PCa (CSPCa). Methods: We designed a prospective, single-center, and comparative study to determine the DR of systematic and targeted cognitive biopsies. The clinical and pathological characteristics of each patient were described. Results: A total of 111 patients with Prostate Imaging Reporting and Data System lesions > 3 were included in the study. PCa was detected in 41.4% (46 of 111 patients); 42 (91.3%) were detected by systematic biopsy and 30 (65.2%) by targeted biopsy. CSPCa was detected in 26 (23.4%), 23 (88.5%) by systematic biopsy, and 21 (76.9%) by targeted biopsy. PSAd > 0.15 was directly associated with CSPCa. Conclusion: The detection of PCa by systematic biopsy in this series was higher than 80%; hence, its routine use should not be replaced by targeted biopsy, since it continues to be the cornerstone of the diagnosis in patients with prior negative biopsies.

The effect of metabolic syndrome on prostate-specific antigen levels: A meta-analysis

@#It has been proposed that Metabolic Syndrome causes an inadvertent lowering of PSA levels in affected individuals.@*OBJECTIVE@#This study aimed to determine the effect of metabolic syndrome on the serum PSA level.@*METHODS@#Literature search was done using MEDLINE and Cochrane databases. The primary outcome measure was serum prostate-specific antigen (PSA) levels. Secondary outcome measures included prostate volume, plasma volume, and PSA mass density. Mean differences were computed using Review Manager 5.3 software.@*RESULTS@#There were six articles available for analysis with a total of 33,775 in metabolic syndrome group (MS) and 70,305 in non-metabolic syndrome group (NM). Overall, there was no significant difference between the PSA levels between MS and NM group. The prostate and plasma volume were significantly higher in the MS compared with NM, having mean difference of 2.95 mL (95% CI, 1.41 to 4.49) and 162.68 mL (95% CI, 120.24 to 205.11), respectively. However, there were no significant difference in the PSA mass density between metabolic and non-metabolic syndrome.@*CONCLUSION@#Metabolic syndrome does not affect PSA levels and PSA mass density, despite increase in hemodilution.

Design and Implementation of the Prostate Cancer Screening System Based on Internet / 医学信息学杂志

The paper introduces the design and implementation of the prostate cancer screening system based on Internet,including the general situation,process,module,software and hardware architecture,etc.The system informationizes and processizes the key examinations during prostate cancer screening,improves the screening quality,and provides more patients with accurate medical service.

Realidad actual del screening para cáncer de próstata: ¿se llevan a cabo las recomendaciones? / Current reality of the screening for prostate cancer: are we carrying out the recommendations?

INTRODUCCIÓN: El cáncer de próstata es la segunda causa de muerte por cáncer en hombres, al igual que en países desarrollados. A pesar de la alta prevalencia y mortalidad, no existen programas de amplia cobertura para detección precoz en la población masculina. OBJETIVO: Determinar la prevalencia del tamizaje para cáncer de próstata en hombres de diversos centros de salud de Santiago de Chile. METODOLOGÍA: Encuesta dirigida a hombres mayores o igual de 40 años que consultaron a centros de salud por causas no urológicas. Se preguntó respecto a edad, realización de exámenes de detección de cáncer de próstata e inicio de controles para pesquisa. RESULTADOS: Respondieron a la encuesta 517 hombres, con una edad promedio de 59 años. Un 50,3 por ciento de los encuestados refirieron haber tenido control para detección de cáncer de próstata alguna vez en su vida. Se observó una mayor proporción de pacientes controlados en un centro de alto nivel socioeconómico de la ciudad, y de un Hospital, en comparación a otros 3 centros. La mayor parte de los controlados tenían más de 60 años, y sólo un tercio inició los controles antes de los 50 años. Finalmente, sólo un 50 por ciento de los controlados se habían realizado tanto medición de antígeno prostático específico como el examen digital rectal. CONCLUSIÓN: La cobertura del screening para cáncer de próstata es baja en la población masculina de Santiago de Chile. Además, la mayor parte de los pacientes inician los controles a edades tardías.

BACKGROUND: In Chile, prostate cancer is the second leading cause of cancer death in men, similar to developed countries. Despite the high prevalence and mortality, there are no established screening programs for early detection. AIM: To evaluate the prevalence of the prostate cancer screening method in different centers of Santiago. MATERIALS AND METHODS: A questionnaire was applied to men 40 years or older to determine age, performing some prostate screening, age at first screening, and which type of screening has been performed. RESULTS: The questionnaire was answered by 517 men, mean age 59 years. 50,3 percent reported had control for detection of prostate cancer at least one time in their life. A higher proportion of patient controlled was observed in a high socioeconomic center of the city and a hospital, compared to other 3 centers. Most of the controlled were over 60 years, and only one third of the controlled started before 50 age. Finally, only 50 percent had done prostate specific antigen plus digital rectal examination. CONCLUSION: The screening for prostate cancer is low in the male population of Santiago de Chile. Furthermore, most patients stars controls at later ages.

Usefulness of Rapid PSA Kit(R) / 대한비뇨기과학회지

PURPOSE: The incidence rate of prostate cancer has increased remarkably in Korea. The serum prostate specific antigen (PSA) value has been used for screening, although its clinical significance in prostate cancer screening is still inconclusive. However, if the measurement time was short and the cost was low, such an assay kit should be sufficient for prostate cancer screening. MATERIALS AND METHODS: We developed pared monoclonal antibodies against PSA which could be used in assay kits for PSA. The Rapid PSA Kit(R) used an immunochromatographic method to qualitatively judge a positive or negative result. Serum specimens from 78 men with benign prostate hyperplasia or prostate cancer were tested using the kit. RESULTS: The sensitivity of the kit was determined to be 4ng/ml. 33 samples had a value of greater than 5ng/ml, so were considered positive. 5 samples had values between 4ng/ml and 5ng/ml, of which 3 were positive. The other 40 samples had values less than 4ng/ml, and 11 of these were judged positive. These results indicated that the sensitivity and specificity of the Rapid PSA Kit(R) were 94.7 and 72.5%, respectively. CONCLUSIONS: Tests using the Rapid PSA Kit(R) can be easily performed at outpatient clinics or elsewhere. This kit is useful in the initial screening of prostate cancer as the results can be obtained within 15 minutes and the cost is lower than with ordinary serum PSA tests.

Usefulness of Rapid PSA Kit(R) / 대한비뇨기과학회지

PURPOSE: The incidence rate of prostate cancer has increased remarkably in Korea. The serum prostate specific antigen (PSA) value has been used for screening, although its clinical significance in prostate cancer screening is still inconclusive. However, if the measurement time was short and the cost was low, such an assay kit should be sufficient for prostate cancer screening. MATERIALS AND METHODS: We developed pared monoclonal antibodies against PSA which could be used in assay kits for PSA. The Rapid PSA Kit(R) used an immunochromatographic method to qualitatively judge a positive or negative result. Serum specimens from 78 men with benign prostate hyperplasia or prostate cancer were tested using the kit. RESULTS: The sensitivity of the kit was determined to be 4ng/ml. 33 samples had a value of greater than 5ng/ml, so were considered positive. 5 samples had values between 4ng/ml and 5ng/ml, of which 3 were positive. The other 40 samples had values less than 4ng/ml, and 11 of these were judged positive. These results indicated that the sensitivity and specificity of the Rapid PSA Kit(R) were 94.7 and 72.5%, respectively. CONCLUSIONS: Tests using the Rapid PSA Kit(R) can be easily performed at outpatient clinics or elsewhere. This kit is useful in the initial screening of prostate cancer as the results can be obtained within 15 minutes and the cost is lower than with ordinary serum PSA tests.

Cost-effectiveness Analysis of Prostate Cancer Screening

To determine the optimal strategy for prostate cancer screening, the cost-effectiveness of screening was analyzed using a medical decision model. One hundred thousand asymptomatic males between the ages of 40 and 69 were modeled with and without screening. The subjects were divided into three 10−year age groups. We used a 5−year survival rate as an effectiveness point and assumed after 5 year survival free from prostate cancer. We considered three potential programs: 1)screening with digital rectal examination(DRE), 2)screening with prostate specific antigen(PSA), and 3)screening with a combination of DRE and PSA. The study was analyzed from the payer’s perspective, and only direct medical costs were included. For each of the three age groups, PSA screening was more cost−effective than either DRE screening or a combination of DRE and PSA screening. The cost−effectiveness ratio for the combination of DRE and PSA screening was 1.1−2.3 times more expensive than that of PSA screening. If the compliance rate for work−up exams is 80%, the cost−effectiveness of prostate cancer screening is approximate to that of gastric cancer screening. In conclusion, PSA screening is the most cost−effective strategy for prostate cancer screening when compared with both DRE and the combination of DRE and PSA screening. But prostate cancer screening should be carefully conducted, taking the cost−effectiveness of the different strategies and target groups into consideration.

Age-related Serum Prostate Specific Antigen Levels in Korean Men / 대한비뇨기과학회지

PURPOSE: Many physicians now use serum prostate specific antigen(PSA) to screen the prostate cancer in asymptomatic men. Normal distribution of PSA values was determined and age-related serum PSA ranges were well established in the white. Until recently, studies conducted to establish the normal serum PSA values have involved few Asian populations. We aimed to establish normal distribution of serum PSA levels in Korean men and to elucidate PSA variation among different races by comparing this result with those of Caucasian and Japanese. MATERIALS AND METHODS: Between May 1995 and June 1997, 5,805 healthy Korean men aged 30 to 79 years who visited our hospital for regular health checkup were entered a prospective study for early screening of prostate cancer. All men underwent detailed clinical examinations including digital rectal examination(DRE) and serum PSA determination. Any man who was over 50 years old with an abnormal DRE and/or elevated serum PSA(>4.0ng/ml) underwent transrectal ultrasonography(TRUS). Twenty seven men underwent a TRUS-guided sextant prostatic biopsy and 4 were found to have cancer who were excluded from this analysis. RESULTS: Median serum PSA concentration is 0.77ng/ml for 4th decade(n=1,382); 0.78ng/ml for 5th decade(n=1,776); 0.85ng/ml for 6th decade(n=1,775); 1.03ng/ml for 7th decade(n=746); 1.32ng/ml for 8th decade(n=122). Serum PSA concentration is correlated with age(p<0.01) with increase by approximately 0.019ng/ml per year, but its statistical correlation was weak(r=0.14). There were almost no change in median PSA concentration and 95th percentile values until 50 years of age, while gradual increase over ages in fifties. The age-specific ranges of median serum PSA of Korean males were lower than those of Caucasian and a little higher than those of Japanese whose ages were fifties and sixties. Ninety fifth percentile value of serum PSA for Korean men were lower than those of Caucasian or Japanese up to age in sixties but were higher in age in seventies than that for Japanese. CONCLUSIONS: Contrary to earlier observations that serum PSA is strongly correlated with age, the influences of age on serum PSA are thought to be weaker in Korean. These findings imply that serum PSA levels in Korean males associated with prostate disease may be lower than that of Western male. These characteristics might not have the potential to make the age-specific serum PSA range more discriminating for detecting clinically significant cancers in Korean.